• Jens-Peter Kühn, Andreas Hoene, Martin Miertsch, Tobias Traeger, Soenke Langner, Norbert Hosten, and Ralf Puls.
• Department of Diagnostic Radiology and Neuroradiology, Ernst Moritz Arndt University, Greifswald, Germany. kuehn@uni-greifswald.de
• AJR Am J Roentgenol. 2011 May 1; 196 (5): 1189-93.

ObjectiveThe purpose of this study is to assess the efficacy of intraarterial thrombolysis in acute and semiacute occlusions of the lower limb.Materials And MethodsA total of 77 native arteries and 52 bypass grafts were investigated in 129 patients (mean [± SD] age, 64.6 ± 11.1 years) with acute (i.e., symptoms for ≤ 14 days) or semiacute (i.e., symptoms for > 14 days) peripheral arterial occlusions of the lower limb treated by catheter-directed recombinant tissue plasminogen activator (rt-PA) thrombolysis. Therapeutic success was retrospectively analyzed according to vessel type and duration of occlusion. Morbidity and mortality rates associated with thrombolytic treatment were calculated. The hospitalization period after primary intervention was recorded. Reinterventions and amputations were assessed at 12-month follow-up.ResultsRecanalization was accomplished by rt-PA thrombolysis in 73.6% of all cases. There was no difference in primary therapeutic success between native arteries and bypass grafts (p = 0.601). Thrombolysis was more effective in acute peripheral occlusions, and hospital stays were shorter than those for patients with semiacute occlusion (p = 0.001). The morbidity rate was 31% (minor complications, 20.2%; major complications, 10.9%), and the mortality rate was 2.3%. Within 12 months, radiologic and surgical interventions were necessary for 27 patients. The limb salvage rate after primarily successful recanalization was 89.5%.ConclusionIntraarterial rt-PA thrombolysis is an effective and reasonable method for treating acute peripheral arterial occlusion. The method is less effective in semiacute occlusions, leading to extended hospitalization. Within 12 months, a quarter of the patients required reinterventions, and amputations were necessary in 10% of the cases.

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